Self-rated health: patterns in the journeys of patients with multi-morbidity and frailty
Self-rated health: patterns in the journeys of patients with multi-morbidity and frailty
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DOI：
10.1111/jep.12133
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发表时间：
2014-12-01
影响因子：
2.4
通讯作者：
Martin, Carmel Mary
中科院分区：
文献类型：
--
作者：
Martin, Carmel Mary
基本原理、目的和目的自评健康（SRH）是流行病学研究中医院利用和健康结果的单一预测指标。在临床环境中，很少有关于患者旅途中SRH的研究。SRH所反映的对压力源恢复力的降低，使老年人（复杂系统）面临住院的风险。提出SRH反映而不是预测病情恶化和住院情况；在时间序列上具有低SRH自相关。目的是调查护理指南给病人的定期出站电话（平均每两周）的SRH波动。方法采用定量自回归方法对SRH时间序列进行描述性案例分析和定性案例分析。从患者旅程记录系统（PaJR）数据库中随机选择14名参与者。PaJR数据库记录了198名在三个初级保健机构连续取样的老年多病患者的旅程。分析包括三个分析的SRH（0个非常差- 6个优秀）模式的三角测量：SRH毕业与服务利用的关联；时间序列建模（自相关、步进预测）；并对退化进行定性分类。结果14例患者在随访13 +/- 6.4个月的818个电话中报告平均SRH 2.84（差公平）。在24%的电话中，SRH是不公平的，与医院使用显著相关。14个时间序列的SRH自相关性较低（-0.11 ~ 0.26），但差异不大（chi(2) = 6.46, P = 0.91）。健康状况好坏之间的波动非常普遍，健康状况不佳与住院有关。目前尚不清楚为什么一些患者继续走下坡路，而另一些不稳定的患者似乎完全恢复，甚至随着时间的推移有所改善。结论：SRH反映了个体复杂的健康轨迹，但在本研究中，作为单一指标并不能预测何时以及如何发生恶化。个别病人表现得像复杂的适应系统。SRH的动力学及其对不稳定的影响值得进一步研究。
Rationale, aims and objectives Self-rated health (SRH) is a single measure predictor of hospital utilization and health outcomes in epidemiological studies. There have been few studies of SRH in patient journeys in clinical settings.Reduced resilience to stressors, reflected by SRH, exposes older people (complex systems) to the risk of hospitalization. It is proposed that SRH reflects rather than predicts deteriorations and hospital use; with low SRH autocorrelation in time series.The aim was to investigate SRH fluctuations in regular outbound telephone calls (average biweekly) to patients by Care Guides.Methods Descriptive case study using quantitative autoregressive techniques and qualitative case analysis on SRH time series. Fourteen participants were randomly selected from the Patient Journey Record System (PaJR) database. The PaJR database recorded 198 consecutively sampled older multi-morbid patients journeys in three primary care settings. Analysis consisted of triangulation of SRH (0 very poor - 6 excellent) patterns from three analyses: SRH graduations associations with service utilization; time series modelling (autocorrelation, and step ahead forecast); and qualitative categorization of deteriorations. Results Fourteen patients reported mean SRH 2.84 (poor-fair) in 818 calls over 13 +/- 6.4 months of follow-up. In 24% calls, SRH was poor-fair and significantly associated with hospital use. SRH autocorrelation was low in 14 time series (-0.11 to 0.26) with little difference (chi(2) = 6.46, P = 0.91) among them. Fluctuations between better and worse health were very common and poor health was associated with hospital use. It is not clear why some patients continued on a downward trajectory, whereas others who destabilized appeared to completely recover, and even improved over time.Conclusion SRH reflects an individual's complex health trajectory, but as a single measure does not predict when and how deteriorations will occur in this study. Individual patients appear to behave as complex adaptive systems. The dynamics of SRH and its influences in destabilizations warrant further research.